Provider Demographics
NPI:1447544200
Name:CHARLENE L. HAYNES
Entity type:Organization
Organization Name:CHARLENE L. HAYNES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:210-545-4772
Mailing Address - Street 1:16793 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2349
Mailing Address - Country:US
Mailing Address - Phone:210-545-4772
Mailing Address - Fax:210-545-5350
Practice Address - Street 1:16793 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2349
Practice Address - Country:US
Practice Address - Phone:210-545-4772
Practice Address - Fax:210-545-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04268TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154466449OtherMEDICARE NPI
TX1154466449OtherMEDICARE NPI
TXU11949Medicare UPIN